Dietary Intake of the Italian PHIME Infant Cohort: How We Are Getting Diet Wrong from as Early as Infancy.

Unhealthy dietary habits established in early infancy may lead to under or over nutrition later in life. This paper describes the energy, nutrients and food-type intake of 18-month-old infants belonging to the Italian PHIME cohort (n = 389) and evaluates adherence to the Italian dietary reference values (DRVs). Infant dietary data were collected using 7-day dietary records. Mean energy, macro and micronutrient intakes were estimated and compared with the DRVs. The percentage contribution of 19 selected food groups to total energy and macro- and micronutrient intake was determined with the aim of establishing the main food sources. Most infants' diet shared common characteristics: poor variety, excessive intake of proteins (16.5 E% vs. 8-12 E% DRV) and saturated fatty acids (SFAs) (13.8 E% vs. <10 E% DRV), mainly derived from milk and dairy products, and low intake of total fats (33.2 E% vs. 35-40 E% DRV), polyunsaturated fatty acids (PUFAs) (3.1 E% vs. 5-10 E% DRV), vitamin D (1.1 vs. 15 µg/day DRV) and iron (4.5 vs. 8 mg/day DRV). The unbalanced distribution of macronutrients was reflected in energy intakes outside DRV ranges for more than half the infants. Public health interventions promoting healthy eating habits from early on, even from pregnancy, could yield significant short- and long-term health benefits.

Patterns of nutrients' intake at six months in the northeast of Italy: a cohort study.

BACKGROUND: Adequate complementary feeding is recognized as an important predictor of health later in life. The objective of this study was to describe the feeding practices and nutrients' intake, and their association with breastfeeding at six months of age, in a cohort of infants enrolled at birth in the maternity hospital of Trieste, Italy. METHODS: Out of 400 infants enrolled at birth, 268 (67%) had complete data gathered through a 24-hour feeding diary on three separate days at six months, and two questionnaires administered at birth and at six months. Data from feeding diaries were used to estimate nutrients' intakes using the Italian food composition database included in the software. To estimate the quantity of breastmilk, information was gathered on the frequency and length of breastfeeds. RESULTS: At six months, 70% of infants were breastfed and 94% were given complementary foods. The average daily caloric intake was higher in non-breastfed (723 Kcal) than in breastfed infants (547 Kcal, p < 0.001) due to energy provided by complementary foods (321 vs. 190 Kcal, p < 0.001) and milk (363 vs. 301 Kcal, p = 0.007). Non-breastfed infants had also higher intakes of carbohydrates, proteins, and fats. The mean intake of macronutrients was within recommended ranges in both groups, except for the higher protein intake in non-breastfed infants. These consumed significantly higher quantities of commercial baby foods than breastfed infants. CONCLUSIONS: Contrary to what is recommended, 94% of infants were not exclusively breastfed and were given complementary foods at six months. The proportion of daily energy intake from complementary foods was around 50% higher than recommended and with significant differences between breastfed and non-breastfed infants, with possible consequences for future nutrition and health.

Specially formulated foods for treating children with moderate acute malnutrition in low- and middle-income countries.

BACKGROUND: Moderate acute malnutrition, also called moderate wasting, affects around 10% of children under five years of age in low- and middle-income countries. There are different approaches to addressing malnutrition with prepared foods in these settings; for example, providing lipid-based nutrient supplements or blended foods, either a full daily dose or in a low dose as a complement to the usual diet. There is no definitive consensus on the most effective way to treat children with moderate acute malnutrition. OBJECTIVES: To evaluate the safety and effectiveness of different types of specially formulated foods for children with moderate acute malnutrition in low- and middle-income countries, and to assess whether foods complying or not complying with specific nutritional compositions, such as the WHO technical specifications, are safe and effective. SEARCH METHODS: In October 2012, we searched CENTRAL, MEDLINE, LILACS, CINAHL, BIBLIOMAP, POPLINE, ZETOC, ICTRP, mRCT, and ClinicalTrials.gov. In August 2012, we searched Embase. We also searched the reference lists of relevant papers and contacted nutrition-related organisations and researchers in this field.     SELECTION CRITERIA: We planned to included any relevant randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before-and-after studies (CBAs), and interrupted time series (ITS) that evaluated specially formulated foods for the treatment of moderate acute malnutrition in children aged between six months and five years in low- and middle-income countries. DATA COLLECTION AND ANALYSIS: Two authors assessed trial eligibility and risk of bias, and extracted and analysed the data. We summarised dichotomous outcomes using risk ratios (RR) and continuous outcomes using mean differences (MD) with 95% confidence intervals (CI). Where appropriate, we combined data in meta-analyses using the random-effects model and assessed heterogeneity. The quality of evidence was assessed using GRADE methods. MAIN RESULTS: Eight randomised controlled trials, enrolling 10,037 children, met our inclusion criteria. Seven of the trials were conducted in Africa. In general, the included studies were at a low risk of bias. There may have been a risk of performance bias as trial participants were aware which intervention group they were in, but we did not consider this likely to have biased the outcome measurement. We were unable to assess the risk of reporting bias in half of the trials and two trials were at high risk of attrition bias. Any specially formulated food versus standard care - the provision of food increased the recovery rate by 29% (RR 1.29, 95% CI 1.20 to 1.38; 2152 children, two trials; moderate quality evidence), decreased the number dropping out by 70% (RR 0.30, 95% CI 0.22 to 0.39; 1974 children, one trial; moderate quality evidence), and improved weight-for-height (MD 0.20 z-score, 95% CI 0.03 to 0.37; 1546 children, two trials; moderate quality evidence). The reduction in mortality did not reach statistical significance (RR 0.44; 95% CI 0.14 to 1.36; 1974 children, one trial; low quality evidence). Lipid-based nutrient supplements versus any blended foods (dry food mixtures, without high lipid content), at full doses - there was no significant difference in mortality (RR 0.93, 95% CI 0.54 to 1.62; 6367 children, five trials; moderate quality evidence), progression to severe malnutrition (RR 0.88, 95% CI 0.72 to 1.07; 4537 children, three trials; high quality evidence), or the number of dropouts from the nutritional programme (RR 1.14, 95% CI 0.62 to 2.11; 5107 children, four trials; moderate quality evidence). However, lipid-based nutrient supplements significantly increased the number of children recovered (RR 1.10, 95% CI 1.04 to 1.16; 6367 children, five trials; moderate quality evidence), and decreased the number of non-recovering children (RR 0.53, 95% CI 0.40 to 0.69; 4537 children, three trials; high quality evidence). LNS also improved weight gain, weight-for-height, and mid-upper arm circumference, although for these outcomes, the improvement was modest (moderate quality evidence). One trial observed more children with vomiting in the lipid-based nutrient supplements group compared to those receiving blended food (RR 1.43, 95% CI 1.11 to 1.85; 2712 children, one trial; low quality evidence). Foods at complementary doses - no firm conclusion could be drawn on the comparisons between LNS at complementary dose and blended foods at complementary or full dose (low quality evidence). Lipid-based nutrient supplements versus specific types of blended foods - a recently developed enriched blended food (CSB++) resulted in similar outcomes to LNS (4758 children, three trials; moderate to high quality evidence). Different types of blended foods - in one trial, CSB++ did not show any significant benefit over locally made blended food, for example, Misola, in number who recovered, number who died, or weight gain (moderate to high quality evidence). Improved adequacy of home diet - no study evaluated the impact of improving adequacy of local diet, such as local foods prepared at home according to a given recipe or of home processing of local foods (soaking, germination, malting, fermentation) in order to increase their nutritional content. AUTHORS' CONCLUSIONS: In conclusion, there is moderate to high quality evidence that both lipid-based nutrient supplements and blended foods are effective in treating children with MAM. Although lipid-based nutrient supplements (LNS) led to a clinically significant benefit in the number of children recovered in comparison with blended foods, LNS did not reduce mortality, the risk of default or progression to SAM. It also induced more vomiting. Blended foods such as CSB++ may be equally effective and cheaper than LNS. Most of the research so far has focused on industrialised foods, and on short-term outcomes of MAM. There are no studies evaluating interventions to improve the quality of the home diet, an approach that should be evaluated in settings where food is available, and nutritional education and habits are the main determinants of malnutrition. There are no studies from Asia, where moderate acute malnutrition is most prevalent.